Friday, 22 May 2015

Weekly Update #83: The Search For Ultrasound

A Call To Action!
elp Dave Sim find the most modern ultrasound digital imaging or MRI clinic in upstate New York.

Bonus Feature:
What’s Wrong With Dave’s Hand Exactly?
"Still getting pain -- right here specifically -- Guyons canal, the ulnar canal tunnel -- the anatomical term for the canal containing the ulnar artery and ulnar nerve right here at the base of your pinkie. The best current guess, and it is just a guess because the physiotherapy isn’t taking the pain away, that what it is is a tear of the triangular fibro cartilage complex, which you can see right here -- that’s the TFCC. Possibly that or possibly damage to the meniscus (Gesundheit!) a disc of cartilage found in some joints serving to adapt the artricular surfaces to each other. You have one meniscus in your wrist and two meniscuses in your knee."
 ~ Dave Sim (Weekly Update #83, 22 May 2015)


A Moment Of Cerebus said...

This just in from John Q by email:

Saw the Friday May 22 Update #83 - Search for Ultrasound and thought I'd direct you to:

(NOTE that I am in no way affiliated with Buffalo MRI - I live in Western NY and hear their commercials on the radio - the jingle popped into my when I read the blog post title.)

The website says "Having met the highest standards of care in radiology, our facility has been honored with Accreditation from the American College of Radiology. Buffalo MRI offers Board Certified Radiologists, Certified Technologists, and the finest imaging technology in the world." and includes a Canadian Customers link on the left hand side menu.

I hope this helps and best to you & Dave.

Sandeep Atwal said...

Thanks John Q!

KevinR said...

If memory serves, one of the key determinants of MRI resolution is the strength of the magnetic field. Older applications were 1.5T but there now are clinics with 3T machines. (Whether there are any in upstate NY is another matter.)

Will Collier said...

If somebody will please pass this on to Dave:

One of my best friends is a radiologist (in Atlanta, not upstate NY), I would be glad to hit him up with any questions about either ultrasound or MRI technology and/or whatever. The CAN Kickstarter guys have my contact info, please feel free to use it.

Jake Capps said...
This comment has been removed by the author.
Jake Capps said...

Compared to last weeks gut punch of an update ths week's was anything but boring. If we go back a few more weeks to where the AV team talked about what could be done with social media...well I'm usure if this have ever been done. If I were to post someone's MRI scan on reddit...without a doubt it would go viral. I can see the artical on Bleeding Cool now..."Dave Sim's Second Opinion". I have the feeling that this will result in a lot of data to look over when it's all said, and done.

Anthony Kuchar said...

Buffalo offers Canadian patients private pay MRI sessions.

From the Website:

We are conveniently located approximately 25 minutes from the Queenston/Lewiston and Peace bridges.

◾We will guarantee an appointment for you within two business days.

◾You will leave Buffalo MRI with your films or CD in hand.

◾A Radiologist's report will be faxed to your doctor's office within 24-48 hours of your study. If you would like to stay the night, we have arranged for discounted hotel rooms across the street for your convenience.

◾You will need a doctor's referral prior to scheduling a study at our facility.

Anonymous said...

Dave talks about the amount of pressure (and angle) needed to do "the tiniest, tiniest" lines on a page. Could he draw in a larger scale (say 2x or 3x the current size) and shrink the art down accordingly on a computer, and then combine images within a comic art page-sized template?

There is no reason theoretically he needs to work at a small scale that taxes his wrist during the production phase as long as he is able to control the dimensions of the final product.


--Claude Flowers

Geoffrey D. Wessel said...

Re: Claude Flowers' comments - It think this could be a feasible solution. Bryan Hitch drew pages at 2x normal size for a while now, mostly to meet deadlines (allegedly). That won't help on a ligament tear, however it might help catch up once (IF) those issues are resolved...

--- Geoffrey D. Wessel

Sarah said...

This place also looks promising from their website:

If you give them notice, they will provide your results on CD or film. They do require a physician's referral.

Best of luck!
- Sarah Imrisek

Glen said...

Dave, there are hospitals in Kitchener-Waterloo (Grand River for example) that have the most modern ultra sound machines on the planet. Plus you can take the bus there. No need to rely on someone to take you to Buffalo. Although you might need a referral from your family doctor for an ultra sound appointment.

I live near St. Catharines, Ontario where a new hospital was recently built. I've had ultra sounds and CAT scans done at this hospital for follow-up cancer treatments. All the equipment they used was modern and new, staffed by incredibly kind and compassionate people. I never felt I wasn't receiving the best care in the world.

Canada is not some third world nation.

Sandeep Atwal said...

Thanks for all the comments, keep 'em coming! If Dave doesn't see this info before next Thursday, I'll pass on the details. Dave was in Grand River for his operation a few months ago. Can Glen confirm their equipment is as good as anyplace upstate NY? BTW, the Reddit idea is really good.

Anonymous said...

Dave is making too many assumptions about what is best.

Dave should go see a family doctor, insist on getting some tests done (MRI likely), and seek a referral to a specialist such as a sports medicine doctor or an orthopaedic doctor.

Dave should ask the doctor if an MRI or Ultrasound available in Kitchener-Waterloo will detect his injury, rather than assuming it will not. Dave should advise he is willing to travel in Ontario for faster service (it may be faster in Toronto).

I saw a sports medicine doctor in Toronto about 10 years ago (for my back), got an MRI done in a few weeks, which clearly identified what the problem was. I'm sorry, but Dave's logic is flawed as to why a sports medicine doctor will not be able to help or what test he needs.

An orthopaedic doctor would also be a good idea.

It's possible Dave might not need a referral for a sports medicine clinic. I don't recall if I needed a referral.

Grand River Sports Medicine Centre has two clinics in Kitchener:

Forest Glen Shopping Centre,
700 Strasburg Rd s32
(519) 571-7111

16 Andrew St
Kitchener, ON
(519) 804-9164

Probably worth a call. But Dave should make an appointment with a family doctor right away. He could also try a walk-in clinic, although this is not as good as seeing a family doctor. Dave should get a family doctor in general regardless.

Hang in there Dave!

- Reginald P.

Vitas Povilaitis said...

Being originally from Rochester, NY, I would count on Strong Hospital which is attached to the University of Rochester - prestigious.

Vitas Povilaitis

A Moment Of Cerebus said...

So, I was trying to read that Wikipedia link on the TFCC. Not being a qualified medical practioner it really didn't make much sense to me, however the following statement did jump out at me:

"MRI: is, together with the findings of a careful physical examination, a helpful diagnostic tool to assess the condition of the TFCC. Nevertheless, the incidence of false-positive and false-negative MRI results is high."

...which proves again that you should never Google your own medical issues. It gets you no where!

Glen said...

Sandeep........what makes you think that an ultra sound is any different in Kitchener than in Buffalo?

Canadian hospitals don't go to police auctions to buy their medical resonating equipment.

It comes from the same manufactures who supply every hospital in North America.

Canadian doctors and nurses don't have graduate degrees from a Honduras community college.

Dave will receive the same medical diagnosis in Kitchener as he would in Buffalo. He will get the best of care like he did during his most recent medical emergency.

Anonymous said...

Also, Dave should try out an acupuncturist.

Give one a call. You can generally get appointments very quickly, sometimes same day. When I last went, about 10 years ago, it was $50/visit, but I felt better with each visit and after about 8 visits was almost 100 percent.

There's no harm in it and worth a try.

Here are just a few in Kitchener, but I found more than a dozen:

The Acupuncture Specialist
972 King St W
Kitchener, ON
(519) 571-9996

Acupuncture & Traditional Chinese Medicine Clinic
311 Edwin
Kitchener, ON
(519) 746-9133

Pink Lotus Acupuncture and Wellness Center
111 Water St N
Kitchener, ON
(519) 576-0818

- Reginald P.

Eddie said...

Couple of quick thoughts / considerations:

1) Here in Canada, I had to get a MRI due to a basketball injury several years ago, and I went through my family doctor. The wait time seemed a little ridiculous. Like several months. Talking to other people, it seemed to be a similar experience regarding their wait times (not life threatening injuries here). It might be something specific to the West Coast, or no longer the case, but my first instinct would be that it's probably the same in Ontario.

2) Speculation, but I wonder if sports athletes, people who for whom it is a professional injury (as opposed to a recreational injury) have a way of getting in ahead faster, or go to private sports clinics somewhere. In that case, If Dave was to say that his livelihood depends on it, I wonder if that would speed up things somehow.

Also, I wonder if getting across the level of detail required for the use of his hand in his work might come across using the analogy of something akin to a brain surgeon suregon or something; THAT'S the level of attention to detail and use of his hand required.

3) It's pretty difficult to find a family doctor on this since of the country. More and more doctors are going to work in walk-in clinics and hospitals. In my experience, the quality of care and attention you receive at many of the walk in clinics is really...let's say... less than that you would get at a family doctor, sometimes bordering on "ship 'em in, ship 'em out. DING! Now serving number 43!" I did finally manage to find pretty good one through word of mouth, but if the main goal is just getting the scan results, then it might be an option.

M Kitchen said...

Tracking down a sports specialist wouldn't be a bad idea... and would probably be a good place to start researching.

Millions of $$$ are on the line with those injuries.

Sandeep Atwal said...

Glen, I think it's a question of getting the absolute best care possible. Are all hospitals in North America exactly the same? Are all MRI machines exactly the same across this entire continent? Are all doctors and surgeons exactly the same in all hospitals? Well, of course not, so it's a question of making sure you're definitely getting the best care you can. If that happens to be Kitchener, great, but I don't see what the harm is in making sure.

Eddie said...

Web site for calcating estimated wait times for various health services in different parts of Ontario

Grand River had an estimate of 28 days

Eddie said...

1) Alan Davis has a problem as well with his TFCC too. Not sure what it's like now for him. From his blog back in Dec 2007

As I have mentioned previously, what I euphemistically refer to as my ‘wrist problem’ has
forced me to work at a slower rate and to limit the use of my right hand— less drawing, typing,
using a computer mouse or anything that requires sustained dexterity (but worst of all no
swimming, Badminton or anything that requires vigorous rotational movements or flicks of the
My ‘wrist problem’ IS the result of a broken arm BUT the injury occurred many years ago when I
was thirteen—I took a 30ft nosedive from a tree onto a tarmac playground… fortunately my
head absorbed most of the impact and I escaped with a single fracture of the right ulna.
My arm healed and all seemed well until, in my twenties, my wrist started to sublux (dislocate)
because of a condition known as a 'Triangular fibrocartilage complex injury'. The Ulna (outside
of the wrist), being without a bone to bone joint, is held in place by a web of ligaments that
allow complex rotational movement and act as a cushion between the ulna carpal gap.
Simplistically, the Triangular Fibrocartliage complex is a net that holds the Ulna in place and
the TFCC injury is a ‘gap’ in the net so, depending on the direction of the stress applied, the
Ulna can slip through the gap. The TFCC is a fairly common sporting injury and usually no more
than a minor inconvenience so I never gave it much thought until, as I grew older, the
frequency and severity of subluxing increased to such a degree that it began to destabilise
the Radius Carpal joint—which is far more debilitating. Five or six years ago I was losing a
maximum of two or three weeks a year because of the TFCC injury but last year it was over two
full months.
The wrist joint is extremely sophisticated and any currently available surgical intervention only
offers a very limited reward but carries a high risk of impaired dexterity—and, possibly, an
acceleration in the onset of an arthritic condition.
I can still draw (Its silly things like stiff door-handles, stubborn pen tops and shaking hands
that pose problems) and I may have continued the way I was going for a years, if I kept my hand
permanently strapped up, but I decided to reduce my drawing hours and begin focused
exercises in an to attempt to build up the wrist ligaments and slow the inevitable degradation—
and if I’m really lucky maybe even improve the situation. Time will tell.

Anyway, in the grand scheme of things my ‘wrist problem’ is extremely minor and only really
significant because of its impact on my comic work. I have been able to use my time off to catch
up on DIY, gardening and all those other things I usually neglect, so life is good. Thanks again to all those who expressed concern or support."

You'd think there would be a central artists' forum for these kinds of issues. Given the above, it seems Davis' TFCC injury was the result of a broken arm injury he sustained when he was young. I think I recall Dave took a fall on an icy pavement a few years ago after trying to stop someone's kid from running down the street into traffic or something. I wonder if that may have contributed to the problem here.

2) Spoke to a friend who's sister was a nurse. She mentioned that if the injury was something like a work-place related injury or traffic accident, someone is likely to get an MRI much faster due to the insurance companies not wanting to pay out more money as more time goes on. Not sure if this applies in this case (can artists even insure their hands?), but otherwise, she said a private MRI clinic would probably be much faster and they should have the level of technology capable of doing an accurate diagnosis. Her own dad currently has to wait over 6 months for one.